Thoma Achilleas, Kaur Manraj Nirmal, Tsoi Bernice, Ziolkowski Natalia, Duku Eric, Goldsmith Charles Harry
Hamilton and Toronto, Ontario; and Burnaby, British Columbia, Canada From the Division of Plastic Surgery, Department of Surgery, Department of Clinical Epidemiology and Biostatistics, the Surgical Outcomes Research Center, Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University; Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; and Faculty of Health Sciences, Simon Fraser University.
Plast Reconstr Surg. 2014 Dec;134(6):1093-1107. doi: 10.1097/PRS.0000000000000751.
A previous randomized controlled trial showed no clear superiority of vertical scar over inverted T-shaped reduction mammaplasty in terms of health-related quality of life. No economic evaluation has been undertaken comparing vertical scar reduction and inverted T -shaped reduction.
A total of 255 patients were randomized to either vertical scar or inverted T -shaped reduction. The effectiveness was measured with the Health Utilities Index Mark 3. Direct and productivity costs were captured parallel to the randomized controlled trial. Perspectives of the Ministry of Health, patient, and society were considered.
Inverted T -shaped reduction dominated vertical scar reduction from the Ministry of Health perspective by being slightly less costly ($3090.06 versus $3106.58) and slightly more effective (0.87 quality-adjusted life-years versus 0.86 quality-adjusted life-years). From the societal and patient perspectives, vertical scar reduction was both less costly and less effective. At the commonly quoted Canadian threshold of $50,000 per quality-adjusted life-year gained, the probability that vertical scar reduction was cost-effective was 29.3, 68.2, and 66.9 percent from the Ministry of Health, patient, and societal perspectives. Subgroup analysis of reductions less than 500 g found that vertical scar reduction was more likely cost-effective.
Vertical scar reduction is more likely than not cost-effective from patient and societal perspectives but not from the Ministry of Health perspective at a willingness-to-pay threshold of $50,000 per quality-adjusted life-year. If we limit vertical scar reduction for resections less than 500 g per breast, this technique is more likely cost-effective from all perspectives.
先前的一项随机对照试验表明，就健康相关生活质量而言，垂直切口瘢痕法并不比倒T形乳房缩小术具有明显优势。尚未进行比较垂直切口瘢痕法和倒T形乳房缩小术的经济学评估。
总共255例患者被随机分为垂直切口瘢痕组或倒T形乳房缩小术组。采用健康效用指数第3版来衡量效果。在进行随机对照试验的同时收集直接成本和生产力成本。考虑了卫生部、患者和社会的视角。
从卫生部的视角来看，倒T形乳房缩小术比垂直切口瘢痕法更具优势，其成本略低（3090.06加元对3106.58加元）且效果略好（质量调整生命年为0.87对0.86）。从社会和患者的视角来看，垂直切口瘢痕法成本更低且效果更差。在加拿大常用的每获得一个质量调整生命年50,000加元的阈值下，从卫生部、患者和社会视角来看，垂直切口瘢痕法具有成本效益的概率分别为29.3%、68.2%和66.9%。对切除量小于500克的亚组分析发现，垂直切口瘢痕法更有可能具有成本效益。
从患者和社会视角来看，垂直切口瘢痕法很可能具有成本效益，但在每质量调整生命年支付意愿阈值为50,000加元时，从卫生部视角来看并非如此。如果我们将垂直切口瘢痕法限制用于每侧乳房切除量小于500克的情况，那么从所有视角来看，该技术更有可能具有成本效益。
